Food Fight: The Inside Story of the Food Industry

150 Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis, and What We Can Do About It. Reviewed by Jim Latham, Me 'laster University As waistlines around the world continue to expand, so too does the shelf space devoted to popular and scientific discussions of what is now termed the global obesity"globesity" to steal a line from the WHO-epidemic. Food Fight by Kelly D. Brownell and Katherine Battle Horgen (Contemporary Books, 2004) is a recent addition to this burgeoning literature. The book focuses on the situation in the United States, the global obesity leader, in part to identify policy missteps for other countries to avoid. A central tenet of Food Fight is that the increasing prevalence of obesity follows inexorably from the pairing of human biology with the "toxic environment" created by presentday eating and exercise patterns. Much of the book is devoted to describing this environment and the force-likened to that of a tsunami-with which it shapes public health. In Part 1 (Chapters I to 3), the authors make the case that changing the toxic environment is the most effective approach for halting the spread of the global obesity epidemic. They argue that our hunter-gather past has given us a metabolism tuned to storing calories in times of plenty while modern agriculture provides many with perpetual caloric plenty. In their view, changing the food environment will be both easier and more successful than changing human biology. Part 2 (Chapters 4 to 9) presents and discusses details of the American food and exercise environment. Chapter topics include barriers to exercise (4), the influence of marketing directed to children (5), junk food in schools (6 and 7), expanding p011ion sizes (8), and economic incenti ves for over consumption (9). Evidence from many countries, especially Canada and the UK, is compared and contrasted with US examples.

NEXUS: Volume 17 (2004)

151 Part 3 (Chapters 10 and \1) discusses the role of the food industry (10) in creating the environment described in Part 2 and what can be done to start effecting change (11). In light of the previous chapters~which include tales of governmentindustry coIl usion and industry intimidation of nutrition researchers~it is hard not to despair when reading the strategies for change, which raises one of the central tensions of the book. Brownell and Horgen stress the strength of the environment in shaping the obesity epidemic to counter the suggestion~perhaps more popular in the US than elsewhere~ that failures of "personal responsibility" account for increasing prevalence of overweight and obesity. Making this case, which they do well, risks demoralizing those who would change things. Each chapter is therefore replete with encouraging tales of local actors triumphing over industry interests. A helpful and exh0l1atory summary of recommended actions is included after the final chapter. Entitled "Taking Decisive Action," it has as its epigraph a quote from no less a social campaigner than Mahatmas Gandhi. At times, the desire for change borders on the public-health messianic, and while Battle and Horgen rightly focus on prevention of overweight and obesity in children as very imp0l1ant in creating lasting reductions in obesity prevalence, they do go overboard at times, with statements such as "children need our help" and "appreciate that there .are victims~our children deserve more from us." This detracts from the message that weight loss at all ages carries impol1ant health benefits. Overall, the book succeeds in describing many structural factors fuelling the expansion of America's waistlines and proposing reasonable strategies, from individual- to nationallevel changes, to reverse the trends. Legislative changes (e.g. to farm subsidies, school-lunch program guidelines) seem to hold the most promise for large-scale results. However, given the American public's non-reaction to government perfidy vis-a-vis Iraqi weapons of mass destruction, it is hard to believe that Americans will take to the streets and/or ballot boxes over the lobbying triumphs of the Grocery Manufacturers of America or


152 the knowledge that the American Dietetic Association receives funding from the National Soft Drink Association. A welcome addition to the largely economic focus of the book would have been discussion of different cultural attitudes towards healthy or desirable body weights. This would have been especially suitable in those portions of the book that discuss how the obesity epidemic is spreading and being responded to in various countries of the world. Less forgivable given the economic focus of the book is the brevity of the discussion on povel1y and how it relates to the difficulty of acquiring a nutritious diet. It is rather blithely stated that obesity is more common among the poor and that food is more expensive in poor neighbourhoods. This is oversimplification at best: a comprehensi ve review of the links between obesity and socioeconomic status (Sobal and Strunkard 1989) found such a relationship only among women; more recent work has suggested that links between SES and obesity are strongly influenced by ethnicity, gender, and the country in which the research was done (e.g., McTigue et a!. 2002; Wang 2001). As for food prices, large- scale studies often fail to find that prices vary significantly with neighbourhood affluence-of those that do, many find that prices are lower in poor neighbourhoods. Smaller scale studies checking the price of greater numbers of foods have more often reported higher prices in poorer neighbourhoods, but many of these are often done by advocacy organizations, and some studies, including at least one cited by Battle and Horgen, did not perform statistical tests. These criticisms should not overwhelm what is an admirably comprehensive (from a biomedical/public health point of view) treatment of the obesity epidemic as it stands in America and elsewhere in the world. Especially useful will be the identification of US policies to be avoided. Canadians, who are not far behind the US in losing the battle of the bulge, would do well to make use of this information, and to collect reliable, national-level anthropometric survey data. Exact overweight and obesity prevalence figures are unavai lable at present. The National Longitudinal Study of Children and Youth and National


153 Population Health Survey both rely on self-rep0l1ed or parentally reported data, which are notoriously inaccurate for height and weight. Similarly, there has been little discussion of how agricultural and other policies could be influencing public health. With Krispy Kreme'" donuts making inroads into Ontario, Canadians could soon be heading down the (newly widened) garden path, only a few steps behind the Americans, without even knowing it.

References

McTigue K.M., Van·ett J.M., and Popkin 8.M. 2002 The natural history of the development of obesity in a cohort of young US adults between 1981 and 1998. Annals o(lnternal Medicine 136: 857-864 Sobal, J. and A.J. Stunkard 1989 Socioeconomic status and obesity: A review of the literature. Psvchological Bulletin 105(2): 260-75 Wang, Y. 2001 Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status. International Journal of Epidemiolog)' 30(5): 1136-37
